By Michele Skalicky, 6-12-13
Liliane Sparks of Hollister has health problems that prevent her from using a hyperbaric chamber to help heal her wounds. But without the proper treatment of the deep wounds on her feet, she faced amputation. Her doctor, Bob Dorsey at CoxHealth in Branson, suggested maggot debridement therapy.
That’s where maggots—anywhere from 50 to hundreds of the larvae—are placed in a wound, covered with a bandage and allowed to do what they do—eat dead tissue.
According to Dorsey, who specializes in wound care at CoxHealth, maggots only debride dead tissue and that’s the advantage of using them.
"Me, as a general surgeon, anytime I debride a wound, I generally end up taking some healthy tissue with that, and we don't like to take healthy tissue," he says. "Therefore, I use maggots in certain wounds to clean up the wounds and debride the wounds and to help clear the infection."
At last check, Sparks was responding well to the treatment.
Anyone with a necrotic wound that contains dead tissue is a candidate for maggot debridement therapy. They’re used in conjunction with other methods such as antibiotics and diabetic control. And, these aren’t just any maggots—they come from Monarch labs in California where they’re radiated so they can’t reproduce.
Dorsey has treated several patients with maggots so far. The first two, he says, were both elderly.
"They both smoke. They both are diabetic, uncontrolled with their sugars in the 3 to 400 range," he says. "Our last ditch effort to prevent them from both getting a below knee amputation is we've tried maggots to clean the wounds up, and they've done well and turned the tide."
Barriers, like chiffon fabric, are placed around the wound so the maggots can’t escape.
"It's small enough to keep the initial size of the maggots from crawling through," says Dorsey.
After two days, the wound is checked and Dorsey decides whether or not to order more maggots to continue treatment.
Maggots are ordered as needed—they’re not kept on site and they arrive at CoxHealth in a small container, which Dorsey describes as being similar to a urine sample cup.
The use of maggots in medicine goes back to ancient times. During the Civil War, doctors noticed that patients with maggots in their wounds did better.
Dorsey believes he’s the only physician in the Branson/Northern Arkansas region who is using the therapy. He says it’s becoming more and more accepted—but it takes the right patient to decide they want maggots crawling around in their wound.
Reactions to the therapy have been mixed.
"Some of 'em, 'ew, no,' and some of 'em, 'ok, whatever it takes to help heal my wound,'" he says.
The US Food and Drug Administration has classified both medical maggots and medicinal leeches as medical devices.
Image: Maggots in a container at the London Zoo in London, UK.